Questions and Answers ​in MRI
  • Home
  • Complete List of Questions
  • …Magnets & Scanners
    • Basic Electromagnetism >
      • What causes magnetism?
      • What is a Tesla?
      • Who was Tesla?
      • What is a Gauss?
      • How strong is 3.0T?
      • What is a gradient?
      • Aren't gradients coils?
      • What is susceptibility?
      • How to levitate a frog?
      • What is ferromagnetism?
      • Superparamagnetism?
    • Magnets - Part I >
      • Types of magnets?
      • Brands of scanners?
      • Which way does field point?
      • Which is the north pole?
      • Low v mid v high field?
      • Advantages to low-field?
      • Disadvantages?
      • What is homogeneity?
      • Why homogeneity?
      • Why shimming?
      • Passive shimming?
      • Active shimming?
    • Magnets - Part II >
      • Superconductivity?
      • Perpetual motion?
      • How to ramp?
      • Superconductive design?
      • Room Temp supercon?
      • Liquid helium use?
      • What is a quench?
      • Is field ever turned off?
      • Emergency stop button?
    • Gradients >
      • Gradient coils?
      • How do z-gradients work?
      • X- and Y- gradients?
      • Open scanner gradients?
      • Eddy current problems?
      • Active shielded gradients?
      • Active shield confusion?
      • What is pre-emphasis?
      • Gradient heating?
      • Gradient specifications?
      • Gradient linearity?
    • RF & Coils >
      • Many kinds of coils?
      • Radiofrequency waves?
      • Phase v frequency?
      • RF Coil function(s)?
      • RF-transmit coils?
      • LP vs CP (Quadrature)?
      • Multi-transmit RF?
      • Receive-only coils?
      • Array coils?
      • AIR Coils?
    • Site Planning >
      • MR system layout?
      • What are fringe fields?
      • How to reduce fringe?
      • Magnetic shielding?
      • Need for vibration testing?
      • What's that noise?
      • Why RF Shielding?
      • Wires/tubes thru wall?
  • ...Safety and Screening
    • Overview >
      • ACR Safety Zones?
      • MR safety screening?
      • Incomplete screening?
      • Passive v active implants?
      • Conditional implants?
      • Common safety issues?
      • Projectiles?
      • Metal detectors?
      • Pregnant patients?
      • Postop, ER & ICU patients?
      • Temperature monitoring?
      • Orbital foreign bodies?
      • Bullets and shrapnel?
    • Static Fields >
      • "Dangerous" metals?
      • "Safe" metals?
      • Magnetizing metal?
      • Object shape?
      • Forces on metal?
      • Most dangerous place?
      • Force/torque testing?
      • Static field bioeffects?
      • Dizziness/Vertigo?
      • Flickering lights?
      • Metallic taste?
    • RF Fields >
      • RF safety overview?
      • RF biological effects?
      • What is SAR?
      • SAR limits?
      • Operating modes?
      • How to reduce SAR?
      • RF burns?
      • Estimate implant heating?
      • SED vs SAR?
      • B1+rms vs SAR?
      • Personnel exposure?
      • Cell phones?
    • Gradient Fields >
      • Gradient safety overview
      • Acoustic noise?
      • Nerve stimulation?
      • Gradient vs RF heating?
    • Safety: Neurological >
      • Aneurysm coils/clips?
      • Shunts/drains?
      • Pressure monitors/bolts?
      • Deep brain stimulators?
      • Spinal cord stimulators?
      • Vagal nerve stimulators?
      • Cranial electrodes?
      • Carotid clamps?
      • Peripheral stimulators?
      • Epidural catheters?
    • Safety: Head & Neck >
      • Additional orbit safety?
      • Cochlear Implants?
      • Bone conduction implants?
      • Other ear implants?
      • Dental/facial implants?
      • ET tubes & airways?
    • Safety: Chest & Vascular >
      • Breast tissue expanders?
      • Breast biopsy markers?
      • Airway stents/valves/coils?
      • Respiratory stimulators?
      • Ports/vascular access?
      • Swan-Ganz catheters?
      • IVC filters?
      • Implanted infusion pumps?
      • Insulin pumps & CGMs?
      • Vascular stents/grafts?
      • Sternal wires/implants?
    • Safety: Cardiac >
      • Pacemaker dangers?
      • Pacemaker terminology?
      • New/'Safe" Pacemakers?
      • Old/Legacy Pacemakers?
      • Violating the conditions?
      • Epicardial pacers/leads?
      • Cardiac monitors?
      • Heart valves?
      • Miscellaneous CV devices?
    • Safety: Abdominal >
      • PIllCam and capsules?
      • Gastric pacemakers?
      • Other GI devices?
      • Contraceptive devices?
      • Foley catheters?
      • Incontinence devices?
      • Penile Implants?
      • Sacral nerve stimulators?
      • GU stents and other?
    • Safety: Orthopedic >
      • Orthopedic hardware?
      • External fixators?
      • Traction and halos?
      • Bone stimulators?
      • Magnetic rods?
  • …The NMR Phenomenon
    • Spin >
      • What is spin?
      • Why I = ½, 1, etc?
      • Proton = nucleus = spin?
      • Predict nuclear spin (I)?
      • Magnetic dipole moment?
      • Gyromagnetic ratio (γ)?
      • "Spin" vs "Spin state"?
      • Energy splitting?
      • Fall to lowest state?
      • Quantum "reality"?
    • Precession >
      • Why precession?
      • Who was Larmor?
      • Energy for precession?
      • Chemical shift?
      • Net magnetization (M)?
      • Does M instantly appear?
      • Does M also precess?
      • Does precession = NMR?
    • Resonance >
      • MR vs MRI vs NMR?
      • Who discovered NMR?
      • How does B1 tip M?
      • Why at Larmor frequency?
      • What is flip angle?
      • Spins precess after 180°?
      • Phase coherence?
      • Release of RF energy?
      • Rotating frame?
      • Off-resonance?
      • Adiabatic excitation?
      • Adiabatic pulses?
    • Relaxation - Physics >
      • Bloch equations?
      • What is T1?
      • What is T2?
      • Relaxation rate vs time?
      • Why is T1 > T2?
      • T2 vs T2*?
      • Causes of Relaxation?
      • Dipole-dipole interactions?
      • Chemical Exchange?
      • Spin-Spin interactions?
      • Macromolecule effects?
      • Which H's produce signal?
      • "Invisible" protons?
      • Magnetization Transfer?
      • Bo effect on T1 & T2?
      • How to predict T1 & T2?
    • Relaxation - Clincial >
      • T1 bright? - fat
      • T1 bright? - other oils
      • T1 bright? - cholesterol
      • T1 bright? - calcifications
      • T1 bright? - meconium
      • T1 bright? - melanin
      • T1 bright? - protein/mucin
      • T1 bright? - myelin
      • Magic angle?
      • MT Imaging/Contrast?
  • …Pulse Sequences
    • MR Signals >
      • Origin of MR signal?
      • Free Induction Decay?
      • Gradient echo?
      • TR and TE?
      • Spin echo?
      • 90°-90° Hahn Echo?
      • Stimulated echoes?
      • STEs for imaging?
      • 4 or more RF-pulses?
      • Partial flip angles?
      • How is signal higher?
      • Optimal flip angle?
    • Spin Echo >
      • SE vs Multi-SE vs FSE?
      • Image contrast: TR/TE?
      • Opposite effects ↑T1 ↑T2?
      • Meaning of weighting?
      • Does SE correct for T2?
      • Effect of 180° on Mz?
      • Direction of 180° pulse?
    • Inversion Recovery >
      • What is IR?
      • Why use IR?
      • Phase-sensitive IR?
      • Why not PSIR always?
      • Choice of IR parameters?
      • TI to null a tissue?
      • STIR?
      • T1-FLAIR
      • T2-FLAIR?
      • IR-prepped sequences?
      • Double IR?
    • Gradient Echo >
      • GRE vs SE?
      • Multi-echo GRE?
      • Types of GRE sequences?
      • Commercial Acronyms?
      • Spoiling - what and how?
      • Spoiled-GRE parameters?
      • Spoiled for T1W only?
      • What is SSFP?
      • GRASS/FISP: how?
      • GRASS/FISP: parameters?
      • GRASS vs MPGR?
      • PSIF vs FISP?
      • True FISP/FIESTA?
      • FIESTA v FIESTA-C?
      • DESS?
      • MERGE/MEDIC?
      • GRASE?
      • MP-RAGE v MR2RAGE?
    • Susceptibility Imaging >
      • What is susceptibility (χ)?
      • What's wrong with GRE?
      • Making an SW image?
      • Phase of blood v Ca++?
      • Quantitative susceptibility?
    • Diffusion: Basic >
      • What is diffusion?
      • Iso-/Anisotropic diffusion?
      • "Apparent" diffusion?
      • Making a DW image?
      • What is the b-value?
      • b0 vs b50?
      • Trace vs ADC map?
      • Light/dark reversal?
      • T2 "shine through"?
      • Exponential ADC?
      • T2 "black-out"?
      • DWI bright causes?
    • Diffusion: Advanced >
      • Diffusion Tensor?
      • DTI (tensor imaging)?
      • Whole body DWI?
      • Readout-segmented DWI?
      • Small FOV DWI?
      • IVIM?
      • Diffusion Kurtosis?
    • Fat-Water Imaging >
      • Fat & Water properties?
      • F-W chemical shift?
      • In-phase/out-of-phase?
      • Best method?
      • Dixon method?
      • "Fat-sat" pulses?
      • Water excitation?
      • STIR?
      • SPIR?
      • SPAIR v SPIR?
      • SPIR/SPAIR v STIR?
  • …Making an Image
    • From Signals to Images >
      • Phase v frequency?
      • Angular frequency (ω)?
      • Signal squiggles?
      • Real v Imaginary?
      • Fourier Transform (FT)?
      • What are 2D- & 3D-FTs?
      • Who invented MRI?
      • How to locate signals?
    • Frequency Encoding >
      • Frequency encoding?
      • Receiver bandwidth?
      • Narrow bandwidth?
      • Slice-selective excitation?
      • SS gradient lobes?
      • Cross-talk?
      • Frequency encode all?
      • Mixing of slices?
      • Two slices at once?
      • Simultaneous Multi-Slice?
    • Phase Encoding >
      • Phase-encoding gradient?
      • Single PE step?
      • What is phase-encoding?
      • PE and FE together?
      • 2DFT reconstruction?
      • Choosing PE/FE direction?
    • Performing an MR Scan >
      • What are the steps?
      • Automatic prescan?
      • Routine shimming?
      • Coil tuning/matching?
      • Center frequency?
      • Transmitter gain?
      • Receiver gain?
      • Dummy cycles?
      • Where's my data?
      • MR Tech qualifications?
    • Image Quality Control >
      • Who regulates MRI?
      • Who accredits?
      • Mandatory accreditation?
      • Routine quality control?
      • MR phantoms?
      • Geometric accuracy?
      • Image uniformity?
      • Slice parameters?
      • Image resolution?
      • Signal-to-noise?
      • Ghosting?
  • …K-space & Rapid Imaging
    • K-space (Basic) >
      • What is k-space?
      • Parts of k-space?
      • What does "k" stand for?
      • Spatial frequencies?
      • Locations in k-space?
      • Data for k-space?
      • Why signal ↔ k-space?
      • Spin-warp imaging?
      • Big spot in middle?
      • K-space trajectories?
      • Radial sampling?
    • K-space (Advanced) >
      • K-space grid?
      • Negative frequencies?
      • Field-of-view (FOV)
      • Rectangular FOV?
      • Partial Fourier?
      • Phase symmetry?
      • Read symmetry?
      • Why not use both?
      • ZIP?
    • Rapid Imaging (FSE &EPI) >
      • What is FSE/TSE?
      • FSE parameters?
      • Bright Fat?
      • Other FSE differences?
      • Dual-echo FSE?
      • Driven equilibrium?
      • Reduced flip angle FSE?
      • Hyperechoes?
      • SPACE/CUBE/VISTA?
      • Echo-planar imaging?
      • HASTE/SS-FSE?
    • Parallel Imaging (PI) >
      • What is PI?
      • How is PI different?
      • PI coils and sequences?
      • Why and when to use?
      • Two types of PI?
      • SENSE/ASSET?
      • GRAPPA/ARC?
      • CAIPIRINHA?
      • Compressed sensing?
      • Noise in PI?
      • Artifacts in PI?
  • …Contrast Agents
    • Contrast Agents: Physics >
      • Why Gadolinium?
      • Paramagnetic relaxation?
      • What is relaxivity?
      • Why does Gd shorten T1?
      • Does Gd affect T2?
      • Gd & field strength?
      • Best T1-pulse sequence?
      • Triple dose and MT?
      • Dynamic CE imaging?
      • Gadolinium on CT?
    • Contrast Agents: Clinical >
      • So many Gd agents!
      • Important properties?
      • Ionic v non-ionic?
      • Intra-articular/thecal Gd?
      • Gd liver agents (Eovist)?
      • Mn agents (Teslascan)?
      • Feridex & Liver Agents?
      • Lymph node agents?
      • Ferumoxytol?
      • Blood pool (Ablavar)?
      • Bowel contrast agents?
    • Contrast Agents: Safety >
      • Gadolinium safety?
      • Allergic reactions?
      • Renal toxicity?
      • What is NSF?
      • NSF by agent?
      • Informed consent for Gd?
      • Gd protocol?
      • Is Gd safe in infants?
      • Reduced dose in infants?
      • Gd in breast milk?
      • Gd in pregnancy?
      • Gd accumulation?
      • Gd deposition disease?
  • …Cardiovascular and MRA
    • Flow effects in MRI >
      • Defining flow?
      • Expected velocities?
      • Laminar v turbulent?
      • Predicting MR of flow?
      • Time-of-flight effects?
      • Spin phase effects?
      • Flow void?
      • Why GRE ↑ flow signal?
      • Slow flow v thrombus?
      • Even-echo rephasing?
      • Flow-compensation?
      • Flow misregistration?
    • MR Angiography - I >
      • MRA methods?
      • Dark vs bright blood?
      • Time-of-Flight (TOF) MRA?
      • 2D vs 3D MRA?
      • MRA parameters?
      • Magnetization Transfer?
      • Ramped flip angle?
      • MOTSA?
      • Fat-suppressed MRA?
      • TOF MRA Artifacts?
      • Phase-contrast MRA?
      • What is VENC?
      • Measuring flow?
      • 4D Flow Imaging?
      • How accurate?
    • MR Angiography - II >
      • Gated 3D FSE MRA?
      • 3D FSE MRA parameters?
      • SSFP MRA?
      • Inflow-enhanced SSFP?
      • MRA with ASL?
      • Other MRA methods?
      • Contrast-enhanced MRA?
      • Timing the bolus?
      • View ordering in MRA?
      • Bolus chasing?
      • TRICKS or TWIST?
      • CE-MRA artifacts?
    • Cardiac I - Intro/Anatomy >
      • Cardiac protocols?
      • Patient prep?
      • EKG problems?
      • Magnet changes EKG?
      • Gating v triggering?
      • Gating parameters?
      • Heart navigators?
      • Dark blood/Double IR?
      • Why not single IR?
      • Triple IR?
      • Polar plots?
      • Coronary artery MRA?
    • Cardiac II - Function >
      • Beating heart movies?
      • Cine parameters?
      • Real-time cine?
      • Ventricular function?
      • Tagging/SPAMM?
      • Perfusion: why and how?
      • 1st pass perfusion?
      • Quantifying perfusion?
      • Dark rim artifact
    • Cardiac III - Viability >
      • Gd enhancement?
      • TI to null myocardium?
      • PS (phase-sensitive) IR?
      • Wideband LGE?
      • T1 mapping?
      • Iron/T2*-mapping?
      • Edema/T2-mapping?
      • Why/how stress test?
      • Stess drugs/agents?
      • Stress consent form?
  • …MR Artifacts
    • Tissue-related artifacts >
      • Chemical shift artifact?
      • Chemical shift in phase?
      • Reducing chemical shift?
      • Chemical Shift 2nd Kind?
      • In-phase/out-of phase?
      • IR bounce point?
      • Susceptibility artifact?
      • Metal suppression?
      • Dielectric effect?
      • Dielectric Pads?
    • Motion-related artifacts >
      • Why discrete ghosts?
      • Motion artifact direction?
      • Reducing motion artifacts?
      • Saturation pulses?
      • Gating methods?
      • Respiratory comp?
      • Navigator echoes?
      • PROPELLER/BLADE?
    • Technique-related artifacts >
      • Partial volume effects?
      • Slice overlap?
      • Aliasing?
      • Wrap-around artifact?
      • Eliminate wrap-around?
      • Phase oversampling?
      • Frequency wrap-around?
      • Spiral/radial artifacts?
      • Gibbs artifact?
      • Nyquist (N/2) ghosts?
      • Zipper artifact?
      • Data artifacts?
      • Surface coil flare?
      • MRA Artifacts (TOF)?
      • MRA artifacts (CE)?
  • …Functional Imaging
    • Perfusion I: Intro & DSC >
      • Measuring perfusion?
      • Meaning of CBF, MTT etc?
      • DSC v DCE v ASL?
      • How to perform DSC?
      • Bolus Gd effect?
      • T1 effects on DSC?
      • DSC recirculation?
      • DSC curve analysis?
      • DSC signal v [Gd]
      • Arterial input (AIF)?
      • Quantitative DSC?
    • Perfusion II: DCE >
      • What is DCE?
      • How is DCE performed?
      • How is DCE analyzed?
      • Breast DCE?
      • DCE signal v [Gd]
      • DCE tissue parmeters?
      • Parameters to images?
      • K-trans = permeability?
      • Utility of DCE?
    • Perfusion III: ASL >
      • What is ASL?
      • ASL methods overview?
      • CASL?
      • PASL?
      • pCASL?
      • ASL parameters?
      • ASL artifacts?
      • Gadolinium and ASL?
      • Vascular color maps?
      • Quantifying flow?
    • Functional MRI/BOLD - I >
      • Who invented fMRI?
      • How does fMRI work?
      • BOLD contrast?
      • Why does BOLD ↑ signal?
      • Does BOLD=brain activity?
      • BOLD pulse sequences?
      • fMRI Paradigm design?
      • Why "on-off" comparison?
      • Motor paradigms?
      • Visual?
      • Language?
    • Functional MRI/BOLD - II >
      • Process/analyze fMRI?
      • Best fMRI software?
      • Data pre-processing?
      • Registration/normalization?
      • fMRI statistical analysis?
      • General Linear Model?
      • Activation "blobs"?
      • False activation?
      • Resting state fMRI?
      • Analyze RS-fMRI?
      • Network/Graphs?
      • fMRI at 7T?
      • Mind reading/Lie detector?
      • fMRI critique?
  • …MR Spectroscopy
    • MRS I - Basics >
      • MRI vs MRS?
      • Spectra vs images?
      • Chemical shift (δ)?
      • Measuring δ?
      • Backward δ scale?
      • Predicting δ?
      • Size/shapes of peaks?
      • Splitting of peaks?
      • Localization methods?
      • Single v multi-voxel?
      • PRESS?
      • STEAM?
      • ISIS?
      • CSI?
    • MRS II - Clinical ¹H MRS >
      • How-to: brain MRS?
      • Water suppression?
      • Fat suppression?
      • Normal brain spectra?
      • Choice of TR/TE/etc?
      • Hunter's angle?
      • Lactate inversion?
      • Metabolite mapping?
      • Metabolite quantitation?
      • Breast MRS?
      • Gd effect on MRS?
      • How-to: prostate MRS?
      • Prostate spectra?
      • Muscle ¹H-MRS?
      • Liver ¹H-MRS?
      • MRS artifacts?
    • MRS III - Multi-nuclear >
      • Other nuclei?
      • Why phosphorus?
      • How-to: ³¹P MRS
      • Normal ³¹P spectra?
      • Organ differences?
      • ³¹P measurements?
      • Decoupling?
      • NOE?
      • Carbon MRS?
      • Sodium imaging?
      • Xenon imaging?
  • ...Artificial Intelligence
    • AI Part I: Basics >
      • Artificial Intelligence (AI)?
      • What is a neural network?
      • Machine Learning (ML)?
      • Shallow v Deep ML?
      • Shallow networks?
      • Deep network types?
      • Data prep and fitting?
      • Back-Propagation?
      • DL 'Playground'?
    • AI Part 2: Advanced >
      • What is convolution?
      • Convolutional Network?
      • Softmax?
      • Upsampling?
      • Limitations/Problems of AI?
      • Is the Singularity near?
    • AI Part 3: Image processing >
      • AI in clinical MRI?
      • Super-resolution?
  • ...Tissue Properties Imaging
    • MRI of Hemorrhage >
      • Hematoma overview?
      • Types of Hemoglobin?
      • Hyperacute/Oxy-Hb?
      • Acute/Deoxy-Hb?
      • Subacute/Met-Hb?
      • Deoxy-Hb v Met-Hb?
      • Extracellular met-Hb?
      • Chronic hematomas?
      • Hemichromes?
      • Ferritin/Hemosiderin?
      • Subarachnoid blood?
      • Blood at lower fields?
    • T2 cartilage mapping
    • MR Elastography?
    • Synthetic MRI?
    • Amide Proton Transfer?
    • MR thermography?
    • Electric Properties Imaging?
  • Copyright/Legal
    • Copyright Issues
    • Legal Disclaimers
  • Forums/Blogs/Links
  • What's New
  • Self-test Quizzes - NEW!
    • Magnets & Scanners Quiz
    • Safety & Screening Quiz
    • NMR Phenomenon Quiz
    • Pulse Sequences Quiz
    • Making an Image Quiz
    • K-space & Rapid Quiz
    • Contrast & Blood Quiz
    • Cardiovascular & MRA Quiz

Nephrogenic Systemic Fibrosis (NSF)

What is NSF? How does gadolinium cause it?  
Nephrogenic Systemic Fibrosis (NSF)
Nephrogenic Systemic Fibrosis (NSF)
Nephrogenic systemic fibrosis (NSF) is a rare, progressive, often fatal disease characterized by skin thickening, painful joint contractures, and fibrosis of multiple organs including the lungs, liver, muscles, and heart. Nearly all documented cases have occurred in patients with chronic severe renal insufficiency who have received gadolinium contrast. The association between gadolinium and NSF was first reported by Danish nephrologists in 2006. Between 2006 and 2010 several hundred cases were diagnosed worldwide.
NSF usually develops clinically within days to months following gadolinium exposure, although rare cases have been reported years later. Nearly all patients have been in various degrees of renal failure and many were on dialysis. Only exceedingly rare cases have been reported in patients with eGFRs > 30 mL/min/1.73m².  High and/or multiple doses of contrast are frequently reported, as are the use of linear contrast agents (ACR Group I). Other risk factors include liver diease and acidosis.
Nephrogenic Systemic Fibrosis (NSF)
The strong association with renal insufficiency most likely relates to the prolonged biological half-life due to prolonged excretion of gadolinium. However, other factors have been imputed, including metabolic acidosis; elevated iron and phosphate levels; erythropoietin therapy; vasculopathy; and infectious/inflammatory mediators.

The pathogenesis of NSF is believed to begin with the displacement of the Gd ion from its chelate by another metallic cation (Fe+3, Zn+2, or Ca+2) through a so-called transmetalation reaction :

(Metal ion) + Gd-Chelate ↔ Metal-Chelate + Gd+3

The free Gd ion is then deposited in the skin and other soft tissues. There it is engulfed engulfed by CD163+ iron-recycling and other macrophages creating an inflammatory response and cytokine release. Circulating fibrocytes (immunologically unique CD-34 positive cells derived from bone marrow) deposit in tissue, transforming into spindle cells that proliferate and become the hallmark of the disease. 
Following recognition of this disorder and its association with gadolinium in patients with renal insufficiency, the worldwide radiology community responded immediately to put an end to this iatrogenic disease. Today, NSF has been nearly completely eliminated due to these measures. In more recent times, however, gadolinium-induced plaques have been reported in the extremities not meeting the full criteria for NSF.
The story of NSF is sad one that we radiologists created. It should serve as a lesson that even drugs which appear to be extraordinarily safe may not be infinitely safe for all patients. Sometimes adverse effects may be subtle, disguised, or appear at long time intervals following administration. NSF is thus a call and reminder to be forever vigilant.   

Advanced Discussion (show/hide)»

No supplementary material yet. Check back soon!

References
     
Attari H, Cao Y, Elmholdt TR, et al. A systematic review of 639 patients with biopsy-confirmed nephrogenic system fibrosis. Radiology 2019; 292:376-386.
     Abraham JL, Thakral C, Skov L et al. Dermal inorganic gadolinium concentrations:  evidence for in vivo transmetalation and long term persistence in nephrogenic systemic fibrosis. Br J Dermatol 2008; 158: 273–280.
     Bennett CL, Qureshi ZP, Sartor AO, Norris LB, Murday A, Xirasagar S, Thomsen HS. Gadolinium-induced nephrogenic systemic fibrosis: the rise and fall of an iatrogenic disease. Clin Kidney J. 2012; 5: 82–88. 
    Cowper SE, Rabach M, Girardi M. Clinical and histological findings in nephrogenic systemic fibrosis. Eur J Radiol 2008; 66:191-199.
     Elster AD. Energy-dispersive x-ray microscopy to trace gadolinium in tissues. Radiology 1989; 173:868-870. (Method I developed 25 years ago now used to demonstrate Gd accumulation in tissues).
     Gathings RM, Reddy R, Santa Cruz D, Brodell RT. Gadolinium-associated plaques. A new, distinctive clinical entity. JAMA Dermatology 2015; 151:316–319. (rarely, isolated plaques may occur on the extremities, not meeting full criteria for NSF).
     Grobner T. Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006; 21: 1104–1108.
     Krefting I, FDA. Gadolinium-based contrast agents (GBCAs) and the NSF risk: update. 21 January 2011. US Food and Drug Administration. www.fda.gov
     Martin DR. Nephrogenic system fibrosis: a radiologist's practical perspective. Eur J Radiol 2008; 66:220-224.
     Martino F, Amici G, Rostner M, et al. Gadolinium-based contrast media nephrotoxicity in kidney impairment: the physiopathological conditions for the perfect murder. J Clin Med 2021; 10:271.  [DOI LINK]  (good recent review article on the subject).
     Peak AS, Sheller A. Risk factors for developing gadolinium-induced nephrogenic systemic fibrosis. Ann Pharmacother 2007; 41:1481–5.
     Prasad SR, Jagirdar J. Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy: a primer for radiologists. J Comput Assist Tomogr 2008; 32:1-3.
     Schroeder JA, Weingart C, Coras B, et al. Ultrastructural evidence of dermal gadolinium deposits in a patient with nephrogenic systemic fibrosis and end-stage renal disease. Clin J Am Soc Nephrol 2008; 3:968-975.
     Swaminathan S. Gadolinium toxicity: iron and feroportin as central targets. Magn Reson Imaging 2016; 34:1373-1376.

Related Questions
     Is gadolinium contrast nephrotoxic? Can it be given safely to patients with mild renal insufficiency?
      Do all MR contrast agents carry the same risk of NSF? 

←  Previous Question
Next Question  →
↑ Complete List of Questions ↑
© 2024 AD Elster, ELSTER LLC
All rights reserved.   
MRIquestions.com - Home
Donate
Please help keep this site free for everyone in the world!